Lung cancer screening

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Clinical significance of incidental thyroid nodules identified on low-dose CT for lung cancer screening

Clinical significance of incidental thyroid nodules identified on low-dose CT for lung cancer screening

subjects. The criteria for at-risk patients who would benefit from lung cancer screening have not been established yet in Korea. Therefore, it is likely that a per- centage of the study population is not truly at-risk for malignancy along with those that received voluntary testing. As a result, our cohort of patients may be differ- ent from those used in previous LDCT-based studies. Secondly, we were unable to obtain data regarding smoking status at the time of the study. Since most can- cers are related to smoking, it is important to know how many smokers were included in the study population. Additionally, there may be radiological features of ITNs that are associated with smoking history.
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Serum and blood based biomarkers for lung cancer screening : a systematic review

Serum and blood based biomarkers for lung cancer screening : a systematic review

Molecular biomarkers are potentially useful adjuncts to LDCT for lung cancer screening, either by further delin- eating patient risk prior to LDCT, or assessing malignant risk of positive LDCT findings [1, 4, 6, 9, 10]. The per- formance of any test also depends upon the prior prob- ability of the condition in the population being sampled and this varies considerably [11, 12]. Biomarkers may be generated from cancer cells, the tumor microenviron- ment, or the host response to cancer [4, 13]. Various mo- lecular factors that are implicated in lung carcinogenesis have been evaluated as prognostic and diagnostic bio- markers, such as markers of apoptosis, cellular adhesion, cellular growth, and tumor proliferation [10, 14]. Epigen- etic markers such as DNA methylation, miRNAs, nucleo- some remodeling, and histone modifications have also been investigated [10, 13, 14]. Biomarkers may be sampled from many different bodily sources, including whole blood, serum, plasma, bronchial brushings, and sputum [13, 14]. Circulating blood-based and serum-based bio- markers are a convenient compartment to sample as they are relatively easy and inexpensive to collect [4, 6, 9].
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Primary care providers’ views on a future lung cancer screening program

Primary care providers’ views on a future lung cancer screening program

The National Lung Screening Trial (NLST) in the United States (2) demonstrated and the Lung Cancer Screening Trial Pilot in the United Kingdom (3) suggested that screening with low dose CT scans (LDCT) significantly reduces mortality from lung cancer among high risk individuals aged 55 to 74 years as compared to chest x-rays. In the NLST, there were potential harms associated with LDCT screening (4). Averaged across three annual lung scans, 11.2% of screens were followed by an extra scan (with additional radiation), 0.9% of scans led to diagnosis of lung cancer (10-15% of which would not have appeared during the patient’s remaining life), 0.5% of scans led to biopsy or bronchoscopy that did not find cancer, and 0.3% of scans led to surgery that did not reveal lung cancer.
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Challenges and research opportunities for lung cancer screening in China

Challenges and research opportunities for lung cancer screening in China

Smoking and other environmental factors are well- known risk factors that are targeted in primordial or primary prevention of lung cancer. As screening is a secondary prevention approach, secular variation in these risk factors may have non-linear effects on lung cancer incidence [29] and, thus, may complicate the predicted effectiveness of screening. In addition, can- cer screening motivated smokers to quit, as ex-smokers concerned with their health status were more willing to participate in the United Kingdom Lung Cancer Screening Trial [30]. Therefore, socio-behaviors should be carefully monitored and considered to take advan- tage of combining programs such as tobacco control and lung cancer screening. A third important factor is that the spectrum of cancer pathological type may change along with changes in environmental risk fac- tors, which further complicates the issue. Therefore, future research should also be placed in a broader con- text and investigate the impact of policies on tobacco control and environment protection, which are cur- rently undergoing significant changes in China.
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Cost effectiveness of lung cancer screening programs : comparing the NLST and NELSON screening

Cost effectiveness of lung cancer screening programs : comparing the NLST and NELSON screening

The goal of a screening program is to detect tumors in a stage when patients are asymptomatic, treatment is most successful and treatment costs are lower. 5 Screening for lung cancer is feasible for three different reasons. 6,7 First, lung cancer has a poor prognosis with an average survival rate of 17%. 8 A significant increase in survival rate can be achieved in case a tumor is detected in early stage. Stage I has an average five-year survival rate of 65.9% versus 0.1% of a stage IV tumor. 9,10 Currently, only 15% of tumors are detected in stage I to III. 1 A second opportunity for screening is the easy identified risk group. Tobacco smoking is the most important cause of lung cancer. The probability for heavy smokers to develop lung cancer is 33% higher when compared to non-smokers. 11–13 The American Cancer Society reports a life time probability of developing lung cancer of 6.3% for women and 7.7% for men. Smoking accounts for 87% of lung cancer deaths among men and 70% of lung cancer deaths among women. 14 The third reason for introducing screening is the decrease in short-term costs in case tumors can be detected in an earlier stage. Healthcare costs attributable to lung cancer amount to 8.4% ($449.5 million) and 9.7% ($12.1 billion) of total cancer costs in the Netherlands and the US respectively. 15,16 This is mostly made up out of treatment costs and depends strongly on tumor stage. In 2000, treatment costs of a 72 year old patient in the US in stage IV were 23.8% higher than treatment costs in stage I/II. 7 Several other countries have started lung cancer screening trials. 3,17–22 The NEderlands-Leuvens
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Implementing lung cancer screening: baseline results from a community-based ‘Lung Health Check’ pilot in deprived areas of Manchester

Implementing lung cancer screening: baseline results from a community-based ‘Lung Health Check’ pilot in deprived areas of Manchester

In this paper, we report baseline results from UK t community-based, LDCT lung cancer screening service, utilising mobile CT scanners. Our approach was to target high-risk individuals in deprived areas of Manchester, with an invitation to convenient community- based L H C s with immediate access to CT. We selected the screened population according to individual risk scores (PLCO M2012 ). The prevalence of lung cancer was

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Participation in lung cancer screening programs: are there gender and social differences? A systematic review

Participation in lung cancer screening programs: are there gender and social differences? A systematic review

A number of screening trials for early detection of lung cancer have been, or are be- ing, conducted using both chest X-ray (CXR) and low-dose computed tomography (LDCT) screening. The latter is the superior method; it is more sensitive than CXR and has enabled detection of small, asymptomatic lung tumors. Early diagnosis by LDCT screening led to a substantial 20% reduction in lung cancer-specific mortality and a sig- nificant 6.7% reduction in all-cause mortality in the US National Lung Screening Trial [4]. A lung cancer screening program with LDCT is a complex endeavor with the pur- pose of identifying asymptomatic patients affected by lung cancer at an early stage, thereby maximizing the odds of a curative treatment without causing harm to healthy participants. As LDCT screening is currently being implemented on an extensive, population-wide, scale in several countries [5, 6], it seems probable that lung cancer screening will enter the health care arena, irrespective of whether it is privately or pub- lically funded. However, several expert panels have highlighted the need for further im- provements of LDCT screening before implementation [7].
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Piloting electronic screening forms in primary care : findings from a mixed methods study to identify patients eligible for low dose CT lung cancer screening

Piloting electronic screening forms in primary care : findings from a mixed methods study to identify patients eligible for low dose CT lung cancer screening

The National Lung Screening Trial in the United States and the Lung Cancer Screening Trial in the United Kingdom have demonstrated that screening with low dose computed tomography (LDCT) scans significantly reduces mortality from lung cancer [1, 2]. Optimal methods to identify potentially eligible asymptomatic patients in primary care are not known, although web- based technologies may be useful. For example, soft- ware is now available which allows patients attending primary care appointments to receive and respond to electronic questionnaires before their consultation. Re- sponses to electronic questionnaires can then be used for different purposes such as determining eligibility for clin- ical studies, populating the electronic medical record (EMR) and providing an opportunity for ‘just-in-time’ counseling by primary care providers (PCPs). For example, in New Zealand, researchers developed an electronic tool for primary care called eCHAT (electronic case-finding and help assessment tool) [3]. The tool was used by pa- tients in the waiting room prior to a visit or via the Inter- net in the community. The goal of the tool was to encourage active participation by patients in decision- making and self-management practices.
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Why and how would we implement a lung cancer screening program?

Why and how would we implement a lung cancer screening program?

For decades, lung cancer has been the most common cancer in terms of both incidence and mortality. There has been very little improvement in the prognosis of lung cancer. Early treatment following early diagnosis is considered to have potential for development. The National Lung Screening Trial (NLST), a large, well-designed randomized controlled trial, evaluated low-dose computed tomography (LDCT) as a screening tool for lung cancer. Compared with chest X-ray, annual LDCT screening reduced death from lung cancer and overall mortality by 20 and 6.7 %, respectively, in high-risk people aged 55 – 74 years. Several smaller trials of LDCT screening are under way, but none are sufficiently powered to detect a 20 % reduction in lung cancer death. Thus, it is very unlikely that the NLST results will be replicated. In addition, the NLST raises several issues related to screening, such as the high false-positive rate, overdiagnosis and cost. Healthcare providers and systems are now left with the question of whether the available findings should be translated into practice. We present the main reasons for implementing lung cancer screening in high-risk adults and discuss the main issues related to lung cancer screening. We stress the importance of eligibility criteria, smoking cessation programs, primary care physicians, and informed-decision making should lung cancer screening be implemented. Seven years ago, we were waiting for the results of trials. Such evidence is now available. Similar to almost all other cancer screens, uncertainties exist and persist even after recent scientific efforts and data. We believe that by staying within the characteristics of the original trial and appropriately sharing the evidence as well as the uncertainties, it is reasonable to implement a LDCT lung cancer screening program for smokers and former smokers.
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Lung cancer screening: from imaging to biomarker

Lung cancer screening: from imaging to biomarker

Nine randomized controlled trials evaluating LDCT to screen lung cancer are ongoing worldwide [34-45]. [46] The Lung Screening Study (LSS) was initiated in 2000, whereas the NLST published the first trial results [47] showing a relative 20% reduction in lung cancer specific deaths among participants screened with LDCT versus CXR. The NLST trial in 2002 recruited 53,454 high-risk participants aged 55 or older to undergo three screenings at 1-year intervals with either LDCT or CXR. The LDCT group noted 247 lung cancer deaths per 100,000 person- years compared to 309 deaths in the CXR group. The NLST trial was acclaimed as a major breakthrough in the lung cancer screening field and showed clear evidence of a significant reduction in lung cancer deaths, but raised concerns regarding how to define the high-risk popula- tions and who would benefit from LDCT screening; what is the optimal time to start LDCT screening; how long to follow patients and what intervals to screen; and lastly the overwhelming financial cost of LDCT screening. Time and further research may provide definitive answers regarding the impact of LDCT screening on lung cancer specific mortality at the population level. Additional Table 1 LDCT in lung cancer screening
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Pleural plaques in lung cancer screening by low-dose computed tomography: prevalence, association with lung cancer and mortality

Pleural plaques in lung cancer screening by low-dose computed tomography: prevalence, association with lung cancer and mortality

Bach et al. showed increase of lung cancer risk in associ- ation to asbestos exposure in participants of lung cancer screening trials [31]. In our study, screenees with pleural plaques showed higher risk of lung cancer mortality com- pared to the remainder screenees. We underline that screenees with pleural plaques were diagnosed with ad- vanced stage lung cancer. Hence, we suggest that in- creased mortality could have been driven by a more aggressive pattern of lung cancer in this group of screen- ees. Again, it is apparent that assessment of pleural pla- ques in lung cancer screening participant contributes to the detection of subjects with minor or unknown exposure. For this purpose, the objective assessment of pleural abnormal- ities could be regarded as potential marker of increased risk of lung cancer associated to asbestos exposure, and should be investigated for post-test refinement of subjective risk of lung cancer. Furthermore, from a demographic point of view, detection of pleural plaques in screenees that are not aware of the exposure should prompt active investigation of environmental exposure to asbestos in specific areas.
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Interest in lifestyle advice at lung cancer screening: Determinants and preferences

Interest in lifestyle advice at lung cancer screening: Determinants and preferences

The European position statement on lung cancer screening re- commends low dose computed tomography for high risk populations, with smoking cessation advice offered alongside [1]. The prevalence of tobacco smoking ranges from 10 to 38% between European countries [2]. In England, 17% of adults smoke [3]. However, data from lung screening trials suggests smoking prevalence is likely to be higher among lung screening attendees [4–6]; within the UK Lung Cancer Screening (UKLS) pilot trial, 38.3% of the screening arm were current smokers [4]. Tobacco is the single greatest contributor to cancer burden in the European Union [7]. However, health behaviours tend to cluster, meaning smokers are more likely to engage in other cancer risk beha- viours, including increased alcohol consumption and eating an un- healthy diet [8,9]. These modifiable behaviours contribute to many non-communicable diseases including cancer, cardiovascular and
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Opinions, practice patterns, and perceived barriers to lung cancer screening among attending and resident primary care physicians

Opinions, practice patterns, and perceived barriers to lung cancer screening among attending and resident primary care physicians

The results of our physician survey have some similari- ties and differences to the Hoffman and Ersek studies. First, the proportion of respondents in our survey who agreed or strongly agreed that lung cancer screening is beneficial for patients was lower than that in the South Carolina group (35%–40% versus 75%). Second, unlike the South Carolina study in which 31% of respondents agreed or strongly agreed that LDCT screening is cost-effective, only 6.9% of residents and 19.5% of attending PCPs in our study perceived lung can- cer screening as being cost-effective. Similar to the Hoffman study, cost to patients was the most frequently reported barrier to lung cancer screening among our respondents. While lung cancer screening with LDCT is covered by most of the insur- ance plans for those patients meeting the high-risk definition, the work-up of pulmonary nodules or incidental findings will likely incur out-of-pocket expenses for the patient. Third, providers in all three studies raised concern about the high false-positive rate. In a retrospective analysis, application of the American College of Radiology Lung-RADS to NLST data suggests that use of Lung-RADS may potentially reduce the false-positive rates, 27 which may alleviate some provider
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How Family Physicians in Saskatchewan Make Lung Cancer Screening Decisions

How Family Physicians in Saskatchewan Make Lung Cancer Screening Decisions

The notion that patient factors may lead FPs to override their decision to follow guidelines is further supported by other findings of this study. When asked in a single- item opinion-based question if CXR is recommended for lung cancer screening, 18 participants responded that they perceived that CXR was recommended; yet, when faced with an uncomplicated patient scenario, 23 indicated they would order a CXR. The fact that 48% screened in the Uncomplicated Scenario contrary to prevailing national guidelines, suggests that there must be other factors (besides the complicating factors assessed in this study) influencing their decision-making. In summary, presence of multiple factors (patient anxiety, expectation, positive family history of lung cancer, poor patient-physician relationship) significantly influenced FPs decisions to screen and over- rides their perception of guidelines. These findings illustrate the influence of patient factors on evidence-based medicine for lung cancer screening decision-making.
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Original Article The feasibility of oral mucosa TCT tests for lung cancer screening

Original Article The feasibility of oral mucosa TCT tests for lung cancer screening

promoter region in their tumor suppressor genes [4, 9, 10]. In smokers, both oral and lung tissues are exposed to the same carcinogens and suffer from the same kind of molecular and cellular modifications. Using polymerase chain reaction (PCR), Bhutani and his associates compared tumor suppressor genes p16 in oral mucosa and bronchial mucosa of 125 cases of healthy long-term smokers. In bronchial tissue, the methylation rate in p16, FHIT, and two simultaneous promoters were found to be 23%, 17% and 35% respectively. Methylation rate in p16, FHIT, and two simultaneous promoters were 19%, 15% and 31% respectively in oral tis- sue. The research demonstrated that modifica- tions of anti-oncogenes and promoters in the bronchial tissue had a significant correlation to that in oral tissue (P < 0.0001) [3]. Lung tissue changes caused by smoking can be evaluated by examinations of these changes in oral cavity mucous epithelium. The tumor suppressor genes in oral mucosa and pulmonary epitheli- um of chronic smokers likely undergo similar biological changes. This fact lays the founda- tion for the feasibility of using oral mucosa as a lung cancer screening method.
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LDCT lung cancer screening in populations at different risk for lung cancer

LDCT lung cancer screening in populations at different risk for lung cancer

Some risk assessment models that incorpo- rate additional risk factors have been devel- oped and demonstrated to improve lung cancer screening efficiency in North America and the UK, including PLCO m2012 and Liver- pool Lung Project Model. 3 4 The performance of these models has been evaluated in several studies in the USA, UK, Canada, Germany and Australia, but have not been validated in South America. 3–10

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Proposals for lung cancer screening in the UK

Proposals for lung cancer screening in the UK

In the UK in 1999 lung cancer was responsible for 34 240 deaths (22% of all cancer deaths). Proposals for a randomized controlled trial have been developed by the UK Cancer Coordinating Committee for Research — Lung (UKCCCR). The primary research objective of the UK trial is to determine whether lung cancer screening using low-dose Spiral CT reduces mor- tality from lung cancer. To address this issue a random- ized controlled trial of Spiral CT vs. no screening in smokers, 60 years and over, is proposed, with lung cancer mortality as the primary end-point. Smoking cessation will be offered to both the screened and unscreened group. Initially a pilot trial of 2000 individ- uals is planned, the purpose of which is to determine the feasibility, compliance and costs of a large randomized controlled trial. There will be six participating centres in the pilot.
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Incorporating lung cancer screening education into tobacco
cessation group counseling

Incorporating lung cancer screening education into tobacco cessation group counseling

group tobacco cessation counseling were trained to administer an educational intervention about LCS. The intervention was administered to 25 participants during May 2019 who completed surveys that assessed how much the information provided helped with understanding various aspects of lung cancer screening including benefits, risks, eligibility criteria, and insurance coverage. The intervention also provided information on how to learn more about LCS and assessed the acceptability of the information.

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Lung Cancer Screening

Lung Cancer Screening

or CXR was classified as a positive screen. Of the studies performed, 24.2% of LDCTs and 6.9% of radiographs were positive, with 39% of individuals in the LDCT group and 16% of those in the radiograph group having at least one positive screen during the 3-year period. Of these abnormalities 96.4% were false-positive findings (i.e. they did not lead to a diagnosis of cancer). Although most positive findings were resolved by further imaging, 11% were followed by an invasive diagnostic procedure. The rate of procedure-related complications was low (1.4% of positive screenees in the LDCT group and 1.6% of those in the CXR group experienced a complication). The trial was stopped prematurely as an interim analysis demonstrated a statistically significant reduction of 20% in LC-specific mortality and 6.7% in all- cause mortality in the LDCT arm. The number needed to screen with LDCT to avoid one LC death was 320. [16]
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Defining the information needs of lung cancer screening participants: a qualitative study

Defining the information needs of lung cancer screening participants: a qualitative study

Most focus group participants needed detailed explana- tion of the term ‘overdiagnosis’, though one participant who had a history of prostate cancer described the ‘tiger’ and the ‘sleepy’ cancers, and said ‘But if you get the tiger … you’re in trouble’ (M4, FG68_CS_ED−). Fear of cancer, perhaps accounted for why many felt ‘probably, it wouldn’t stop me being screened’ (M6, FG65_FS_ED+). Some partic- ipants were concerned about being ‘happy, smiley… and suddenly … get told, you’ve got cancer’ (M6, FG64_FS_ED+). Despite this, many felt they would rather know about the cancer and have the option not to treat it. When suggested that it may not always be possible to deter- mine prognosis, participants felt ‘you can’t take that risk’ (F3, FG68_CS_ED−) of not treating. HCPs also acknowl- edged that patients often ‘don’t necessarily want to just say “oh leave it to be”’ (INT51_RP). One RP felt overdiagnosis was a ‘fallacy’ (INT72_RP) and supported the idea that expectant management of some ‘ground glass’ pulmo- nary nodules would reduce overdiagnosis.
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